By Roberta Rasmussen-Merz MSW, RSW, DVATI

For many potential clients and funders the question that often comes up is why choose arts therapy instead of traditional therapy? How does arts therapy work and what does a session look like? Is this a viable option when addressing serious conditions? The following makes a case for arts therapy as Serious Play.

Serious Play is rooted in the universal potential of creativity and its expression

As young boys and girls, we each were artists. We shuffled home from our elementary school classrooms with armloads of brightly coloured works to be displayed on fridge doors and office walls, each piece embodying beauty and affection. We raced around playing super heroes, villains, princesses, knights, monsters and wild beasts. We chanted skipping songs, played music on plastic drums, clunky tambourines and any found object with which we could make a sound. We performed in our basements for invisible audiences. We danced, jumped, rolled, twirled and flew like birds. We told frightening stories in hushed voices during late night sleep overs, re-told jokes, and made up skits to accompany our games. Our imaginations flowed freely, spilling effortlessly into spaces of spontaneous arts based play.

Expressive arts therapists believe that an appreciation of the arts, and participation in its creation, is intrinsic to human existence, inextricably bound with play and the imagination 1. However, the fires of creativity, which burn freely as children, often end up restrained by formal standards that designate what good art should be. Play and art are frequently denied their natural partnership. For those of us who, as adults, display fewer obvious artistic talents, hardly justifying the title of artist, the arts may increasingly feel at best elusive and at worst exclusionary. For others still, innumerable paths of emotional and physical suffering have doused flames and left them languishing in existential soggy, grey, and sooty ashes. Within the field of the expressive arts, art making sparks one’s innate creativity, curiosity, and imagination, so that transformation is made possible.

Engaging in a therapeutic relationship, where the arts are valued and explored as the relational third in a session, effectively marries the innocence of play with the therapeutic seriousness of therapy: Serious Play.

The fields of art therapy and expressive arts therapy are distinct in origin. Art therapy is rooted in the field of psychology, whereas expressive arts was birthed and remains embedded within the arts 2,3. Art therapy is primarily focused on the visual arts, using materials such as paint, chalks, clay, paper, charcoal, inks, images for collage, and digital media. Creative, artistic and imaginative processes are steeped in traditional psychological theory and techniques which make for an easy blending of various forms of talk therapy. One of the founders of expressive arts therapy, Paolo Knill theorizes that all of the arts disciplines are connected to the imagination and are thus naturally intermodal in nature 4; a premium on sensitivity eclipses any need for artistic skill.

Within the expressive arts, the imagination is distilled into the five forms of image, movement, act, word, sound and rhythm which come into being through the arts;

there is no visual art without image, no dance or mime without movement, no theatre without acts, no music without rhythm and sound, no poetry or fiction without words.5

Paolo Knill, 2005
Paolo Knill

Each arts discipline also corresponds to preferred senses: dance relies on the sensorimotor (movement); theatre engages the auditory, sensorimotor and visual; literature and poetry suggest the auditory and visual; while music utilizes the auditory. 6 Perhaps surprisingly, visual art also employs the sensorimotor, and auditory depending on what materials are used, and how one engages in art making.

Embracing the field of expressive arts will enrich an art therapy practice. In my own therapeutic practice, my preferred arts modality is visual art, while the theory and principles of expressive arts flows through my art based sessions and inform my talk based ones. Conversely, art therapy provides the art based avenue for my work and easily integrates with my talk therapy approaches.

A spirit of inclusivity permeates arts therapy which is premised upon the assumption that everyone has the capacity to create and to participate in art making without technical expertise. 7,8,9  Works of art are actively engaged through the senses; when we feel “touched or moved” by an artwork, it “makes sense in its beauty”10. It has been my experience that beauty is something that emerges, beckons, awakens and moves us in some way, refusing imprisonment by a formal measure of its worth.

Within arts therapy, the opposite to this appreciation of beauty or aesthetic is not ugliness but “an-aesthesia - a dullness, an inability to respond.” 11  The concept of aesthetics is considered a response and a responding to both the process and product of art making during a session.

Willingness an asset

Unlike children, adults often present to therapy in a state of an-aesthesia. Cut off from our senses we lose our feeling of connection to the world and our ability to respond in an authentic way 12. A process of sensitization guides connection to our bodies through an immersion into the arts. The art making process is held by the complex relationships among the materials, the emerging artwork, the client and the therapist who witnesses and contains it. These relationships rely upon the development of high sensitivity, which involves gently introducing a client to the art materials and processes. This gradual sensitization motivates the art making process by building a client’s confidence and trust in their own responses.13  In this way, negative experiences or judgements on what good art should be are mitigated and softened. This allows the process and product of art making to be approached and responded to with an appreciation of its particular beauty.

Isn't play just for kids?

Attuning to our senses is an activity which bridges the initial discussion around the problem one comes into therapy to address to engaging the imagination through art making. By expanding one’s experience of play, one is challenged to find untapped capacities and resources. For example, a highly anxious person using a pencil to make small controlled markings may be invited to instead paint or use chalks and a larger piece of paper. This is a way of surprising or challenging someone’s normal way of being, introducing unexpected possibilities. The once narrow, restricted and seemingly hopelessness of the presenting problem may now shift towards hope that change can occur. 14

The fluid potentials of imaginal play are mediated by the skillful choice of frame and materials guided by the art therapist. The size, colour and weight of the paper or canvas create the frame for working in the visual arts and materials may include pastels, paints, clay, pencils, charcoal, or inks. These frames and materials create the structure and containment to work through the psychological content, which may underlie the problem that is being addressed in an implicit way. 15

Stephen Levine 16 speaks to creating possibilities through actively engaging with the world through play:

Play is experimental; it opens up the possibilities of the world. We suffer when there is no play-space, no gap between what we are and what we can be...This is true as much for therapy as for art-making. In order for either to be effective, they must be carried out in an attitude of playfulness, open to possibilities and discovery. 17

The extraordinary experience of artistic play within art making bridges back into the participant's regular life, when their artwork feels complete. It is here where the art making experience is explored and digested and the artwork itself is aesthetically responded to and with; to be harvested for the rich insights it has to offer. 18

Three's company

In arts therapy an artwork is viewed as the third within the therapeutic relationship, independent from the art maker it is treated as a partner in an exchange. There is a common misperception that an art therapist holds some magic interpretative power over a client’s artwork, treating it as if it were a mere object waiting to receive the professionals insights. Conversely, arts therapy views the artwork as an entirely separate entity, not to be interpreted, but rather to be fully engaged. Art making is an act of becoming, giving form to the formless, a voice to the unheard, movement to the bound, colour to the colourless. A work of art does not symbolize a person’s suffering, it gives expression to it and through this expression invites us into relationship. 19

Seriously though

The traditional medical model, upon which many psychological theories are based, focuses on assessing, treating, and curing an individual according to standardized measures. As a client, not reaching these objectives may leave us feeling adrift, floating in a river of failure and hopelessness.

Recognizing the limitations of the medical model, arts therapy seeks to build the capacity to respond and adapt to suffering as a natural part of being human; part of the soul’s nature, rather than a disease to be eradicated. You are no longer considered life’s casualty, but an active participant in exploring different possibilities for being in the world through engaging with the arts in the spirit of play. 20

So what?

We often seek therapy because we feel stuck, overwhelmed, and unable to make sense of and skillfully respond to our circumstances. Habitual ways of being have closed in our world creating obstacles to living fully. Engaging the arts in therapy allows us to access the power of beauty and aesthetics where we can be touched by and respond to our suffering in a compassionate rather than fearful way. Working with our imagination allows for lower-risk experimenting which can lead to surprising solutions, increased flexibility, and different ways of relating to the problem. This is the art of creating possibilities.


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Knill, P.J. (1999). Soul nourishment, or the intermodal language of imagination. In S.K. Levine, & E. G. Levine (Eds.), Foundations of expressive arts therapy: Theoretical and clinical perspectives (pp. 37-52). London: Jessica Kingsley Press.
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